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Angina (chronic stable)

By Laurence O'Toole


Stable angina is a sensation of discomfort or pain in the chest, arm, or jaw brought on predictably by factors that increase myocardial oxygen demand, such as exertion, and relieved by rest or nitroglycerin. Stable angina is usually caused by coronary atherosclerosis, and affects up to 16% of men and 10% of women aged 65-74 years in the UK. Risk factors include hypertension, elevated serum cholesterol levels, smoking, physical inactivity, and overweight.People with angina are at increased risk of other cardiovascular events and mortality compared with people without angina.Among people not thought to need coronary artery revascularisation, annual mortality is 1-2% and annual non-fatal MI rates are 2-3%.We found no long-term, adequately powered RCTs of anti-anginal drugs versus placebo or comparing the use of a single anti-anginal drug versus combinations of anti-anginal drug classes. There is a consensus that monotherapy with beta-blockers, calcium channel blockers, nitrates, and potassium channel openers are effective for treating the symptoms of stable angina in the long term, although we found few studies to confirm this. There is also consensus that the concurrent use of two of these classes of drug has an additional beneficial effect on anginal symptoms and quality of life. It has not been established that this approach reduces cardiovascular events.Monotherapy with beta-blockers or calcium channel blockers seems equally effective at reducing angina attacks, and they are equally well tolerated in the long term. Adding a calcium channel blocker to existing anti-anginal drug treatments slightly reduces the need for coronary artery surgery, but has no effect on other cardiovascular events.Monotherapy with nitrates may be as effective as monotherapy with calcium channel blockers at reducing angina attacks and improving quality of life.We found no RCTs on the effects of long-term monotherapy with potassium channel openers in people with stable angina, but a large RCT of a potassium channel opener as an adjunct to existing anti-anginal drug treatments found a reduction the number of cardiovascular events compared with placebo

Topics: Cardiovascular Disorders
Publisher: BMJ Publishing Group
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Provided by: PubMed Central
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